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Episode 194:
Show Notes 


In the latest episode of the Real Health and Weight Loss podcast, hosts Dr Mary Barson and Dr Lucy Burns, renowned experts in weight management and metabolic health, tackle a topic that frequently confounds followers of the Low Carb Real Food lifestyle: milk. With their combined expertise and passion for empowering listeners, they dive into the nuances of dairy and plant-based milks, providing clarity and guidance on navigating the often perplexing world of milk consumption.

Dairy Milk Dilemma: Full-Cream vs. Low-Fat
Dr Mary and Dr Lucy explore the age-old debate between full-cream and low-fat dairy milk, shedding light on misconceptions and revealing the nutritional differences between the two. Full-cream milk contains essential nutrients and fats that are beneficial for the absorption of vitamins and slowing down digestion. Low-fat or skim milk, while lower in fat, may lack important nutrients and can have an impact on metabolic health.

Plant-Based Milk Options and Considerations
Delving into the realm of plant-based milks, the hosts discuss three categories of individuals who might opt for alternatives: ethical vegans, individuals with dairy allergies, and those with dairy intolerance or inflammatory issues.

Navigating Milk Labels and Ingredients
With a focus on informed decision-making, the hosts emphasise the importance of scrutinising milk labels, highlighting key ingredients to avoid such as seed oils, added sugars, and maltodextrin.

Recommendations for Optimal Choices
Dr Mary and Dr Lucy offer practical recommendations, advocating for almond milk as a low-processed option and coconut milk for its minimal carbohydrate content, while cautioning against highly processed plant milks and lactose-free dairy alternatives.

Armed with evidence-based insights and practical advice from Dr Mary and Dr Lucy, listeners are empowered to make informed decisions about their milk consumption, ensuring that their choices align with their health and wellness goals. 

For more information about Real Life Medicine and our programs and special offers:

Episode 194: 


Dr Mary Barson (0:04) Hello, my lovely friends. I'm Dr Mary Barson.

Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.

Both (0:16) And this is the Real Health and Weight Loss podcast!

Dr Mary Barson (0:23) Good morning, my gorgeous friend. How are you this morning? I'm hoping you have had a fabulous weekend, lovely sleep last night because that's what I've had, which is always wonderful. And I am of course joined by my beautiful hopefully well-slept colleague, Dr Mary. Hello, gorgeous woman. How are you?

Dr Mary Barson  (0:39)  I'm good. And I'm so excited to say that I am well slept. It's lovely. Little baby Max is sleeping through the night and so am I. And I feel good. I feel rested. I feel happy. I feel healthy. And I'm very excited to talk about, I reckon a topic that we get asked about possibly more than anything else.

Dr Lucy Burns (1:07)  Indeed, which is why we thought we'd do a podcast on it because honestly, this seems to cause considerable angst amongst our low-carb real food eaters. So we’re now going to record this podcast and we'll be able to refer you to it. Morning, noon and night whenever you want this fabulous question answered. So Dr Mary, without further ado, what is the question, the burning question on everyone's lips?

Dr Mary Barson  (1:33)  Milk. Milk, milk, milk milk? What milk can I have? What milk can't I have? What about this milk? What about the milk in my coffee? What about the milk in my tea? What about plant milk? What about skim milk? What about cream? Let's talk about milk.

Dr Lucy Burns (1:50)  Indeed. So the first thing is we coined the acronym LCRF, Low Carb Real Food. But honestly, we probably need to reverse it a little bit and go Real Food Low Carb, because by far and away, the most important thing is real food first, and there are plenty of processed low-carb products. So we're not interested in that. So the first thing to say is that milk is a complex topic because it seems obvious but what the hell is milk these days?

Dr Mary Barson  (2:26)  Let's break it down. Let's start with good old dairy cow milk. What about full-cream milk versus low-fat milk dairy milk? Can I have it Lucy? Is it low-carb real food? And what should I know about full-cream milk and skim milk?

Dr Lucy Burns (2:51)  Absolutely. So the first thing to know is that dairy milk, cow's milk, it's what milk used to be in the olden days, there was just milk and you didn't have to qualify it. But we now do and there's some beautiful ad that used to be on with this older woman at a milk bar and some dude walk in and he'd go Can I have some milk and she'd go, and she'd rattle off this list of, you know, low fat, high fat, high protein, low protein, plant milk, soy milk, which milk do you want, and he just got I just want milk the tests like milk. So it is an interesting world to navigate. But let's just divide them into full cream milk, which is your standard milk and low fat milk, skim milk or skinny milk. And that's just milk where the fat has been removed from it. Now, this was done again back in the low fat days because it was thought to be more healthy that it would prevent heart disease. That was actually the premise that saturated fat caused heart disease therefore reducing saturated fat reduces heart disease. That simplistic notion has been fairly well debunked, although the myth still lives on. The thing that happens when you remove the fat from the milk is you also take out quite a lot of the vitamins and quite a lot of the goodness that comes in it. So we need fat in our diet in order to absorb the vitamins. So vitamin D is a fat-soluble vitamin. If you have a product that doesn't have any fat in it, then what is your fat-soluble vitamin sitting in. So it's helpful for many reasons. It's not a portion of the milk that's useless. And the fat within the milk also slows down its passage through our digestive system. So when we drink milk, it goes into our stomach and then it sits there. It's not like a fountain that just sort of moves on through. It sits there And part of the end of the digestion process begins. So, when you interfere with a food in its whole structure, you change the way it's digested. And I think that's really, that point has been missed. For lots of people, including us for a long time, interfering with the structure of a food matters.

Dr Mary Barson  (5:23)  It does. So where does milk like soy food and whole milk, full cream milk here sit within the real food, low carb sort of philosophy? Where do we put milk for saying that full fat milk like whole milk is better than skim milk? And where does it sit in low carb real food world?

Dr Lucy Burns (5:43)  So both the milks have about the same amount of carbohydrates. So when you look at the packet, it'll give you carbohydrates and the carbohydrate in milk is lactose, which is called milk sugar. Most people don't call it milk sugar. In fact, they just call it lactose, but it is its milk sugar. Lactose is a molecule made up of a molecule of glucose and a molecule of galactose joined together to form what's called a disaccharide. So two sugar units joined together sort of di, saccharide is sugar, so that makes sense. So the amount of sugar per 100 mls of milk is about 5 grams, 4.9 grams, so a bit over a teaspoon per 100 grams. So if you drink a cup of milk, then basically you've got the equivalent of about two and a half teaspoons of milk sugar, in that. It's not quite the same as table sugar, because established sugars are different disaccharides. But it's a similar, similar process. So again, if you're drinking a splash, two tablespoons of milk in your coffee, well, that doesn't have that much sugar in it. But if you're drinking 600 mls of it, it does have a lot. And so in the low carb world, we recommend reducing milk or ditching it altogether, if it feels like 20 ml is not useful. And I think what's happened is that, again, as coffee culture has changed, you know, back in the olden days, you have Nescafe, and you had a tablespoon of that in some hot water with a splash of milk. Well, not many people drink coffee like that, these days, they drink it with a latte, so you have your shot. And then it's topped up with a significant amount of milk, depending on the size of the cup. And you may have a significant number of those a day. And so you do end up consuming quite a lot of milk. So that's where it becomes trickier. And so a little workaround for that is you can get the same creaminess of a big latte with a splash of cream. So instead of having 150 ml of milk, you can have a splash of cream, and you top it up with water. And it gives you a similar creamy taste without the sugar load. That's I think the most confusing thing for people. How come I can have cream but I can't have milk? And again, as you know, you're the boss of you can do whatever you want. But if you want to know the effects on your metabolic health and your metabolic hormones, then you need to know this information. And then you make a decision that you're happy with

Dr Mary Barson  (8:40)  Yes, be empowered with the right information, you can drink as many lattes as you want. Just understand that the milk in those lattes is reasonably high in sugar and carbohydrates. But we would say milk is a real food. It's just not necessarily a low carb, real food and so you can make your own decisions about where it fits in for you. 

Dr Lucy Burns (9:03)  But I think it's also just, and again, just a little tip of the hat or nod of the head to feeding families. You know, initially again back in the 80s, everyone was recommended low fat, then they changed the rules, the rules, the guidelines to suggest that children, in particular, should not be eating low fat, or drinking low fat milk that they should be drinking regular milk because of the effects on the developing brain on your fat-soluble vitamins. So again, at Real Life Medicine, we just extend that to everybody. If you're going to drink milk if you want to a splash, pick the higher fat option. It's better. 

Dr Mary Barson  (9:44)  Yeah. And with my metabolically healthy children, I'm quite happy for them to drink milk and to you know, district as much milk as they want because it's a whole food and that's philosophically how I feel. Okay, so that's dairy milk, that's milk milk and cream. What about plant milk? We get asked this a lot. So we're saying okay, dairy milk, it's high in carbs. Just read in the labels. It seems that maybe almond milk is less high in carbs. Can I have as many almond milk lattes as I want is all almond milk. Okay, what advice and information have we got to empower people around plant milks?

Dr Lucy Burns (10:26)  Yeah, so I guess there are two, two sorts of people that might want to choose plant-based milks. One might be if you're philosophically opposed to using animal products, so maybe you're a vegan, vegetarian. And so you prefer to use plant-based milk. That's one person. There are three groups now that think about it, the second people are people who are allergic to cow's milk protein. And that's a significant number of people, including children. So obviously, for you, you would not be recommending any milk or cream or any of that sort of stuff. And the third lot of people who are not necessarily allergic but potentially a bit intolerant, so maybe dairy products, give them gut issues. And for some people, dairy products can be inflammatory, we know that dairy products are mucogenic. So if you get a lot of sinuses if you get asthma, sometimes avoiding dairy products can be helpful for that. The downside for all of those groups is that they miss the benefits of dairy in particular, your fat-soluble vitamins and calcium that come as a natural part of dairy. So we need to be mindful of those. So having said that, people choose alternate milks. And the milk I don't know if the milk is spelt with an i or a y, because you see that around too mylk,  but if we want to look at an alternative, yeah, almond milk is absolutely probably the best I would say of the alternatives as far as a low carbohydrate product goes. Miss, we've had a look at the various milks as you know. So I would like, if you wouldn't mind to share some of our philosophies on why the sorts of things we look for before we make a recommendation.

Dr Mary Barson  (12:24)  Yeah, so all those plant-based milks out there. Coconut milk, almond milk, nut milk, oat milk, and rice milk, they're all fairly processed, and some of them are very processed. And they're not all created equal. There are some commercially available plant milks that are fine, all right, and there are some that are diabolical in terms of their ingredients and processing. Like with nut mix, how many plant milks are made is that they the nuts are, it's nuts, all the grains that hyper-processed, they are sort of smashed up this soaked, and then they are mixed in with oil, seed oils, emulsifiers and gums. Often they have added sugars or other artificial sweeteners thrown in and you can, depending on the brand, or depending on the gradients get quite a toxic cocktail of ultra-processed inflammatory ingredients that are not good for you. Or you can have a product that's not too bad. And so what do you look for exactly and do you want to go for the not too bad one. For reference, I think we all would want that. So you've got to read the labels, you just got to take your glasses, or your reading glasses, if you're me to the supermarket, flip it over and read the ingredients. This is really important. And in an ideal world, if you're buying coconut milk, the ingredients would be coconut milk or coconuts, maybe some water as well. If it's almond milk, you know, you really ideally just want there to be almonds and water in there. Have a look, there are some that are much better than others. And you know, it depends on which part of the world you are as to what are going to be good brands, but you're going to want to especially avoid seed oils, canola oil, sunflower seed oil, you're going to want to avoid sugar, you're going to want void maltodextrin really go for as little ingredients as possible.

Dr Lucy Burns (14:26)  Yeah, absolutely. And it's interesting because I was doing a bit of research before this and looking through and in general, the cheaper the product, the more likely it is processed. And it's tricky because I keep, I still get caught out on this, particularly if I'm ordering some stuff online that maybe I don't usually order. So the other day I did it with dips. And I was buying some dips for something or other and I just didn't know well why would I pay $4 when I can get it for $2 And then when I got the $2 when I go that's why it's $2 because it's full of processed gunk, and it's the same with with the milk. So, interestingly, across the board, soy milk seems to have, I couldn't find any brand in Australia of soy milk that didn't contain canola oil and or emulsifiers. Soy milk is, I mean, it's highly processed. So it's not just some soybeans soaked in water, or mushed-up soybeans soaked in water, because they need to process them intensely in order for that to happen. It's also it's pretty low in protein because basically, it's not. I mean, it sounds like when you look at it, it sort of looks like a product that would be wholesome, because it kind of looks a bit like milk, except that it's not really like it's nothing like milk. When they've not added the emulsifiers, you will find that it looks more like at what it's sort of is, which is that say like almond milk, the almond milk, sediment will sit down the bottom, and then the rest is water. So the first ingredient, most of these plant milks will be water, then the number of percentages, so again, across almond milks at a range from 6% to 1% of almonds in the milk, the best one that I found was a brand that was called Just Almond Milk, which I thought was a good name until I went to the Just Oat Milk, which isn't just oats and water. So the almond milk was almonds, water and salt. But the just oats wasn't it was water, oats, canola oil, salt, something else.

Dr Mary Barson  (16:52)  You have to read the labels.

Dr Lucy Burns (16:53)  Yeah, you do, you have to read the labels, it's much better to have a product that you have to shake, okay, because that means it doesn't have emulsifiers in. It's much better to have a product that maybe sticks together every now and then because that means it doesn't have anticaking agents in it. It's much better to have something with very few ingredients. So yeah, read, read your labels and buy the best quality thing that you can afford. Obviously, we don't want to bankrupt people. And I'm very well aware that with privilege comes choice. So if you're financially able to have the choice, then you are very advantaged and not everyone has that privilege. But whatever you can the best, generally, and again, there's not a blanket rule but generally, the cheaper the product, the nastier the ingredients.

Dr Mary Barson  (17:52)  That's like that the real food aspect of looking at these plant milks, then the other layer is the sugar content or carbohydrate content. And certainly, many of them will have added sugars. But if you're getting unsweetened plant milks, then generally speaking, the least sugary ones are going to be your almond milk and your coconut milk. And with coconut milk, there is a reasonably cheap alternative for most people, which is canned coconut milk. Yes, you're going to have to shake it sort of it separates the watery content, separates from the fatty content. It comes in a can, and it's not super convenient, you know after you've opened it, you need to then decant it to some other storage container and keep it in your fridge. But it's generally fairly cheap and is a pretty low-processed plant milk that you buy and it's generally just got coconuts in it. 

Dr Lucy Burns (18:41)  Yeah, yeah. And I think looking at the range of alternative milks available, we would generally recommend almond milk, as long as it's a low-processed one and coconut milk for the carbohydrate component. The other rice milk, oat milk, and soy milk, in general, are really high in carbohydrates, particularly oat milk, like it has buckets of sugar in it. And when you think about it, well of course it is because what is it, it's just oats, which are essentially carbohydrate soaked, and it's the swill the watery goop once you drain the oats out is the milk. So yeah, it makes sense doesn't it that a grain milk rice milk, it's it they're going to be high. So yeah, I recommend if you don't tolerate dairy, if for whatever reason you don't want to eat or don't eat dairy, then almond milk or coconut milk, is there anything with coconut milk. Coconut tastes like it's pretty pungent. So it's about adapting your tastes you know your coffee is not going to taste the same with coconut milk as it will with almond milk or with milk milk. 

Dr Mary Barson  (19:55)  And you know you can also change your habits and go for it. Black coffee, black tea see how that works out for you as well. But milk up final final point we didn't mention lactose-free milk has just as much sugar. It's just that the sugar content has been altered, but it's still just sugary, I'm adding that in. Yeah. 

Dr Lucy Burns (20:14)  And I think that's important because a lot of people do think lactose-free means it's sugar-free. But what happens for people who are lactose intolerant, is that they lack the enzyme, or they have a reduced amount of enzyme that cleaves those two sugary molecules. So I mentioned glucose and galactose are joined together. And we have the lactase enzyme that splits them apart so that we can digest them. For people who lack that enzyme, you don't digest the disaccharide. And when we don't digest it, we can get gut pain or diarrhea. And that's a common phenomenon. So all the lactose-free milk does is, add that enzyme in. So it's the same amount, still the same carbohydrates still the same glucose. Galactose is actually just broken down to glucose eventually anyway, so it's exactly the same. 

Dr Mary Barson  (21:07)  Yes. I reckon that we've answered our most common questions on milk. Dr Lucy, what do you think?

Dr Lucy Burns (21:12)  Absolutely. So lovelies again, you're the bosses of you, you get to choose your own adventure with the full knowledge that ideally, real food first, if you're insulin resistant, as most of us are in our particularly older years, or then choose a low carbohydrate version. If you don't tolerate dairy, you can use a plant version and there are recommendations.

Dr Mary Barson  (21:35)   Lovely. Alright, gorgeous people go off and enjoy your hot beverages empowered with the right knowledge, and we'll see you again soon. 

Dr Lucy Burns (21:43)  Indeed, bye for now. 

Dr Lucy Burns: (21:48) The information shared on the Real Health and Weight Loss podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.

DISCLAIMER: This Podcast and any information, advice, opinions or statements within it do not constitute medical, health care or other professional advice, and are provided for general information purposes only. All care is taken in the preparation of the information in this Podcast.  Real Life Medicine does not make any representations or give any warranties about its accuracy, reliability, completeness or suitability for any particular purpose. This Podcast and any information, advice, opinions or statements within it are not to be used as a substitute for professional medical, psychology, psychiatric or other mental health care. Real Life Medicine recommends you seek  the advice of your doctor or other qualified health providers with any questions you may have regarding a medical condition. Inform your doctor of any changes you may make to your lifestyle and discuss these with your doctor. Do not disregard medical advice or delay visiting a medical professional because of something you hear in this Podcast. To the extent permissible by law Real Life Medicine will not be liable for any expenses, losses, damages (including indirect or consequential damages) or costs which might be incurred as a result of the information being inaccurate or incomplete in any way and for any reason. No part of this Podcast can be reproduced, redistributed, published, copied or duplicated in any form without the prior permission of Real Life Medicine.